Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. Bone marrow is spongy tissue that fills the cavity of the long bones consisting of fat, red blood cells, and white blood cells. ALL affects the immature white blood cells. This type of cancer is classified by one of two subtypes.

ALL subtype: The subtype of T cell or B cell affects prognosis. Patients with T-cell ALL tend to have a better prognosis than those with mature B-cell ALL.

Response to chemotherapy: Patients who achieve complete remission within 4 to 5 weeks of starting treatment tend to have a better prognosis. Patients who do not achieve remission at any time have a poor prognosis. Evidence of minimal presence of leukemia cells in the bone marrow may also positively affect prognosis.

ALL is the most common cancer occurring in children today and can occur in some adult cases. Children are at the highest risk between 2 and 4 years of age. This risk decreases from age 4 to mid-20s, increasing again after age 50. The average person has a 1 in 1,000 chance of getting ALL. The American Cancer Society estimated the following statistics for 2010:

Approximately 43,050 new cases of all types of leukemia.

Approximately 5,330 new cases of acute lymphoblastic leukemia (1 out of 3 were adult cases).

Most signs and symptoms of ALL mimic those of the flu. However, with ALL these signs and symptoms will not improve. Signs and symptoms include:

Weight loss

Bleeding from the gums

Nosebleeds

Pale skin

Shortness of breath

Fever

Frequent infections

Weakness

Fatigue

Swollen lymph nodes (neck, underarm, groin, stomach)

Red blood cells: These cells carry oxygen throughout the body. A low number of red blood cells can lead to feeling tired or weak, being short of breath and looking pale (anemia). White blood cells: These cells fight infections. A low number of white blood cells can lead to fever and frequent infections that are hard to treat. Platelets: Platelets control bleeding. A low number of platelets can lead to slow healing, easy bruising or bleeding and tiny red spots under the skin (petechiae). Leukemia cells: An increased number of these cells can cause pain in the bones or joints, lack of appetite, headache or vomiting.

Bone marrow test: A needle is used to remove a sample of bone marrow from the hipbone to look for cancerous cells. Through this process, doctors can determine if the cells originated from the B lymphocytes or T lymphocytes according to certain changes in the cancer cells.

Lumbar puncture or spinal tap: A sample of spinal fluid is collected to determine if the cancerous cells have spread.

Imaging: X-ray and computerized tomography (CT) scan can help determine if the cancer has spread to other parts of the body.

The exact causes are unknown. However, there are some risk factors thought to be linked to ALL. These risk factors include:

Gender- slightly more common in males than females

Ethnicity- more common in Caucasians

Chemical exposure or past chemotherapy treatments

Radiation exposure or past radiation treatments

Viral infection

Certain inherited disorders

Down syndrome: The most frequently occurring chromosomal condition occurs when an individual has three copies of the 21st chromosome instead of two. Those with Down syndrome have increased risk for medical conditions such as congenital heart defects, respiratory issues, hearing problems, Alzheimer's disease, childhood leukemia, and thyroid conditions. Klinefelter syndrome: The most common sex chromosome disorder in males. This syndrome occurs when an extra X chromosome is present affects sexual development. Fanconi anemia: This type of inherited anemia is a very rare, recessive genetic disorder that leads to bone marrow failure. Bloom syndrome: This syndrome is a very rare inherited genetic disorder caused by a gene that does not function properly causing an unusually high number of breaks or instability along their chromosomes. This instability causes an increased risk to develop many cancers and leukemia at early ages.Ataxia-telangiectasia: A-T is a genetic progressive disease that affects the immune system occurring in early age. Neurofibromatosis: A genetic disorder that causes tumors to develop in the nervous system.

Systemic Involvement

Pathologic basis for the clinical manifestations of leukemia

Presentation

Cause

anemia, pallor, fatigue, malaise, hypoxia, bleeding

rapidly proliferating development of leukocytes inhibiting erythrocytes and thrombocytes

severe infections, ulcerations of the mouth and throat

high numbers of immature or abnormal leukocytes unable to fight and destroy microorganisms

Treatment for ALL can span from 2 ½ to 3 ½ years depending on each individual situation. General treatment for ALL is broken down into the following 4 phases:

1. Induction therapy: The purpose of this phase is to achieve remission by killing most of the cancer cells in the blood and bone marrow. During the first month, the patient may require many doctor's visits due to increase risk of infections. Patients often receive 3 drugs for the first month of treatment which include:

Chemotherapy drugs injected intrathecally

Steroids

A fourth drug in the anthracycline class is typically added for high-risk patients.

2. Consolidation therapy/ Post- remission therapy: During this more intensive phase, the goal is to destroy any remaining leukemia cells in the central nervous system. This phase of chemotherapy lasts typically 4 to 8 weeks. Intrathecal therapy is continued during this phase.

3. Maintenance therapy: This low dose treatment is given to prevent cancer cell re-growth. During the first few months of this phase, most treatments include 1 to 2 treatments similar to the initial induction. These 4 week intense treatments are called re-induction.

4. Preventive treatment to the spinal cord: Some cancer cells in the central nervous system can not be destroyed by chemotherapy drugs given by oral or intravenous means. During this phase, chemotherapy drugs are injected directly into the spinal cord fluid.

During these 4 phases the specific types of treatments include:

Chemotherapy: Chemotherapy is normally used in the induction therapy stage to kill the cancer cells. This drug can also be used in the consolidation and maintenance phases. All patients need spinal taps to inject chemotherapy into the cerebrospinal fluid (CSF) to kill any leukemia cells that may have spread to the brain and spinal cord. This intrathecal chemotherapy is usually given twice during the first month and four to six times during the next one to two months. It is repeated less often during the rest of consolidation and maintenance. A possible side effect of intrathecal chemotherapy is epileptic seizures during treatment.

Radiation therapy: This treatment uses high-powered beams to destroy cancer cells. This is typically used when the cancer has spread to the central nervous system. Along with intrathecal chemotherapy, high-risk patients and those with leukemia cells detected in their CSF may be given radiation therapy to the brain and spinal cord. Doctors try to avoid this treatment if possible, especially in younger children, because it may cause problems in growth and development.

Stem cell transplant: This transplant may be used for patients at risk or currently going through a relapse. This procedure replaces cancer bone marrow through chemotherapy or radiation with healthy bone marrow from a compatible donor allowing re-establishment of healthy stem cells.

Physical Therapy Management (current best evidence)

Practice Pattern: The practice patterns are determined on an individual basis depending on clinical presentation and response to medical intervention.[6]

The content on or accessible through Physiopedia is for informational purposes only. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more